Field of the Invention
The embodiments described herein are generally directed to the dispensation of prescription medication, and, more particularly, to the automatic or semi-automatic dispensation of prescription medication using a vending-type medication-dispensing machine.
Description of the Related Art
In order to better serve low-income patients, the 340B Drug Pricing Program was made part of the Public Health Service Act, codified as 42 U.S.C. § 256b, in 1992. Under the 340B Drug Pricing Program, drug manufacturers are required to provide outpatient drugs to eligible healthcare organizations and covered entities at significantly reduced prices. The primary goal of the program is to help provide quality healthcare to low-income populations in the form of access to medications that might otherwise be unaffordable. In furtherance of this goal, one of the objectives of the program is to have 100% accountability for both the medications and patient eligibility.
In the past, paper-based prescription systems and extensive networks of pharmacies have made it difficult to ensure accountability. However, in the last several years, the widespread adoption of electronic prescriptions has enabled much better tracking and accountability. Today, approximately 85% of prescriptions are filed electronically. In addition to enabling better tracking of and accountability for medication distribution, electronic prescriptions have also allowed for the accumulation of better and more comprehensive patient data.
For example, data from 2010-2012 demonstrates that approximately 30% of prescriptions are never filled. Thus, 30% of patients visited the doctor and received a prescription, but never picked up the prescription. In addition, 45% of patients who did pick up their prescriptions were no longer following those prescriptions within six months. In other words, these patients failed to pick up refills for their prescriptions.
“Medication non-adherence” refers to instances in which patients do not follow their physicians' prescriptions. Some of the leading causes of medication non-adherence are the time, effort, and inconvenience of visiting a pharmacy to pick up prescribed medications. In fact, the average wait time at a pharmacy is forty-five minutes. Given the inconvenience and inefficiency of the current system, it is not surprising that 30% of prescriptions are never filled.
Side effects of medication non-adherence include hospital readmissions. Specifically, when a patient does not follow his or her doctor's orders to take a particular medication, the end result is often another trip to the hospital or doctor's office. Under the Affordable Care Act of 2010, hospitals are now subject to monetary penalties for readmissions in the form of reductions in Medicare reimbursements. Therefore, hospitals now have even more of an incentive to ensure that patients get quality care and follow the instructions they are given, in order to reduce the number of readmissions.
One way to encourage patients to fill and follow their prescriptions is to make it easy and convenient for them to fill those prescriptions. A vending-type, medication-dispensing machine is one means for streamlining the process for prescription fulfillment. For instance, when the Marin County Clinic in California became aware of the extremely high rate of medication non-adherence for electronic prescriptions, the clinic installed a machine-based medication-dispensing system. As a result, the clinic saw its medication non-adherence rate drop from 30% down to 3.4% in the course of one year. One likely reason for this increase in adherence is that the average time to fill a prescription is now a mere four minutes.
However, the machine-based medication-dispensing system at the Marin County Clinic still requires a licensed pharmacist to be physically present. This is because the California State Board of Pharmacies requires either a licensed pharmacist or a technician under the “direct supervision” of a licensed pharmacist to oversee the “act of dispensing.” The “act of dispensing” is defined as taking the drug off the shelf and affixing the label to it. However, after the drug has been properly identified and labeled, any person can hand it to the patient.
A large clinic, such as the Marin County Clinic, can afford to have a pharmacist physically present at all times. Thus, in such a large clinic, it is not difficult to comply with the rules that govern the dispensation of medications. However, at smaller clinics, pharmacies, or other dispensaries, there may not be enough volume of business to support the presence of a full-time pharmacist.
In order to solve this deficiency in the art, a process is needed which can use a machine to perform the act of dispensing in a manner that satisfies the rules governing the act of dispensing without necessarily requiring the physical presence of a pharmacist. Such a process could reduce the incidence of medication non-adherence, reduce readmissions, and provide better service and care to patients. In addition, the combination of such a process with electronic prescriptions may allow for 100% accountability for the dispensation of medications, including patient identification, as well as documentation that the patient received the prescribed medication. Such accountability is advantageous for Medicare reimbursement and for compliance with the 340B Drug Pricing Program.